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ABSTRACT: OBJECTIVE: To evaluate rates and reasons for treatment discontinuation in couples with male factor infertility and who failed to conceive. DESIGN: Retrospective study. SETTING: Male Sterility Center, University Hospital. PATIENT(S): A total of 407 couples consulting for male factor infertility and who discontinued treatment without conceiving. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Treatment, reasons for dropout, and reproductive outcomes after discontinuation. RESULT(S): Of the 407 patients, 218 (54%) had had fertility treatment (medical or surgical), and 189 (46%) underwent assisted reproductive techniques (ART) (intrauterine insemination [IUI], in vitro fertilization [IVF], or intracytoplasmic sperm injection [ICSI]). The main reasons for dropout were painfulness of treatment (15% for patients with non-ART treatment vs. 32% for patients who had undergone ART), its ineffectiveness (12% vs. 26%), and separation of the couple (18% vs. 7%). Of the 407 patients, 27% consulted in another fertility center, 8% succeeded in having a child by ART with male partner sperm, 1% by ART with donor sperm, and 11% through adoption. CONCLUSION(S): About half of the couples consulting for male factor infertility discontinued fertility treatment, and of those who discontinued only a fifth finally succeeded in having a child. Although support is available to couples during fertility care, ART is a physical and psychological burden.
Fertility and sterility 12/2012; · 3.97 Impact Factor
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ABSTRACT: L’hypospadias est une anomalie du développement dont la traduction la plus évidente est une position ectopique du méat urétral
situé soit sur la face ventrale du gland ou du pénis, soit en position scrotale ou périnéale. La réparation chirurgicale a
pour objectifs de permettre une miction en position debout, une pleine sexualité, et d’obtenir une apparence cosmétique de
la verge aussi normale que possible. Les résultats d’une revue de la littérature sont présentés.
1.
Patients opérés dans l’enfance. Les complications urologiques les plus fréquentes sont les fistules, les diverticules, les
sténoses urétrales, et les difficultés mictionnelles. Le risque infectieux n’est pas augmenté. Le développement psychosocial
n’est past affecté en général, la maturation et le début de l’éveil sexuels sont normaux. Cependant, ces patients présentent
une plus grande difficulté à établir des contacts avec le sexe opposé. A l’âge adulte, les troubles de l’érection et de l’éjaculation
sont fréquents.
2.
Patients opérés à l’âge adulte. Les résultats urologiques de la chirurgie sont moins bons et les complications plus fréquentes
que chez l’enfant. Absence de données sur la sexualité.
3.
Patients qui ne seront jamais opérés. Malgré l’absence d’étude spécifique, ces patients ne semblent pas différer de ceux opérés
dans l’enfance pour ce qui est des troubles mictionnels, du développement psycho-sexuel et de la sexualité.
4.
Capacités reproductives. Les hormones impliquées dans les fonctions testiculaires ne sont en général pas perturbées, que ce
soit chez l’enfant ou chez l’adulte. Toutefois, il existe des facteurs cliniques, histologiques, et spermiologiques susceptibles
de retentir sur la fertilité. Il n’existe pas à ce jour d’évaluation de la fréquence de l’infertilité dans la population des
hommes nés avec un hypospadias et non opérés ou ayant été opérés dans l’enfance.
Hypospadias is a developmental abnormality. The most obvious feature is an ectopic urethral meatus situated on the ventral
aspect of the glans or the penis, or on the scrotum or perineum. This defect occurs in about 1/250 to 1/300 live births. Surgical
repair is designed to allow micturition in a standing position, enable normal sexual function and to give the penis as normal
a cosmetic appearance as possible. This malformation and its treatment have repercussions on psychosocial development, urinary
and sexual function, and reproduction. The literature distinguishes three populations of patients.
1.
Patients who have corrective surgery during childhood. The most frequent urological complications are fistulas, diverticula,
urethral stenosis and micturition difficulties. The risk of infection is not increased. Psychosocial development is usually
not affected, and maturation and early sexual awareness are normal. However, these patients have greater difficulty in making
contact with the opposite sex. In adulthood, problems of erection and ejaculation are frequent.
2.
Patients who have corrective surgery in adulthood. The urological results of surgery are less favourables and complications
are more frequent than in children. No data about sexual function are available.
3.
Patients who do not have surgery. Although there are no specific studies, these patients do not appear to differ from those
operated as children in terms of micturition difficulties, psychosexual development and sexual function.
4.
Reproductive capacity. There is usually no disorder of the hormones involved in testicular function (gonadotropins, androgens)
in either children or adults. However, clinical, histological and spermiological factors may affect fertility.
The frequency of infertility in the population of men who have undergone corrective surgery for hypospadias during childhood
has not yet been evaluated.
Andrologie 04/2012; 15(1):24-34.
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ABSTRACT: To investigate the effects of a mild induced testicular and epididymal hyperthermia (+2°C) on sperm chromatin integrity in men.
Experimental prospective study.
University hospital.
Five healthy fertile volunteers.
Testicular and epididymal hyperthermia was induced by maintaining the testes at inguinal position with the support of specially designed underwear 15 ± 1 hours daily for 120 consecutive days.
Classic semen characteristics. Sperm DNA fragmentation index (DFI) and high DNA stainability (HDS) were analyzed by sperm chromatin structure assay.
Compared with baseline values, sperm DFI and HDS were significantly increased as early as day (D) 20 and D34, respectively, and remained elevated during the entire period of hyperthermia. Percentages of motile and viable spermatozoa decreased as early as D20 and D34, respectively, and total sperm count decreased at D34 during hyperthermia and remained low during the entire hyperthermia period. All studied parameters returned to respective baseline values at D73 after cessation of hyperthermia.
Mild induced testicular and epididymal hyperthermia largely impaired sperm chromatin integrity, which appeared before any changes in sperm output. These findings may have clinical implications in male contraception, infertility, and assisted reproductive technology.
Fertility and sterility 03/2012; 97(3):546-53. · 3.97 Impact Factor
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ABSTRACT: Most studies assessing the outcome of assisted reproductive technologies (ARTs) have reported live birth rates in couples by taking mainly the female factor into account. However, infertility is a couple's concern, and the majority of publications do not take into consideration the true impact of male infertility on having the desired number of children.
We carried out a follow-up study to evaluate the probability of having a child during treatments at the Toulouse Male Sterility Centre and after discontinuation from 2000 through 2008. Couples were followed for at least 4 years until discontinuation of treatment or delivery of a live infant.
We were able to contact 65% of the 1735 male partners by telephone. Of the 1131 respondents, 56% had become parents (60% if adoption is included), 28% after ART, 16% by natural pregnancy, 8% after non-ART treatment and 4% after ART in another centre. The cumulative rates of success reached 64% [95% confidence interval (CI), 60-67] for men ≤35 years and women ≤35 years after 9 years, and 31% (95% CI, 24-39) in older patients. With optimistic analysis, which assumes that patients for whom no information was available have the same chance of success in having a child as those whose reproductive outcome was known, the cumulative rate of success was 48% (95% CI, 45-50) in the 1735 couples.
More than half of couples consulting for male infertility succeeded in having a child. Male age over 35 years old appears as a key risk factor as well as the woman's age, and these findings should encourage couples to attempt parenthood earlier.
Human Reproduction 01/2012; 27(4):1184-90. · 4.47 Impact Factor
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ABSTRACT: We evaluated midodrine as oral treatment for pharmacologically induced priapism in spinal cord injured patients.
From 2004 to 2007 we treated 354 spinal cord injured patients with intracavernous injection of prostaglandin E1 to induce erection. Prolonged erection or priapism occurred in 14 cases (1.3% of intracavernous injections). High blood pressure and bradycardia (autonomic dysreflexia) were noted in 2 tetraplegic cases. Except in 2 patients oral midodrine was used as the only therapeutic approach to this event because of its alpha stimulant properties.
All patients returned to the flaccid penile state within 30 to 45 minutes after midodrine administration. Oral midodrine was well tolerated with few side effects and without increasing the incidence of autonomic dysreflexia. At 6 months complete erection could be again induced by intracavernous injection in all treated patients.
Midodrine administered orally is a simple and efficient treatment for the priapism induced by intracavernous injection of prostaglandin E1. It could be the first line therapeutic approach before more aggressive procedures.
The Journal of urology 08/2009; 182(3):1096-100. · 4.02 Impact Factor
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ABSTRACT: Testis cancer is the most common cancer in young men, and its incidence continues to rise. Even if prognosis is considered as good, a group with bad prognosis still remains. Diagnostic delay (DD), defined as the time elapsing from the onset of tumour symptoms to the day of diagnosis, is a way to evaluate the rapidity of diagnosis. We assessed the relationship between DD, disease stage, and survival rate.
A series of 542 patients diagnosed with a germ cell tumour between 1983 and 2002 at health facilities in the Midi-Pyrenees region, southwest France, were asked about DD. We analysed DD together with data regarding the disease (histologic type, stage), its treatments, and prognosis (impact on survival).
Mean DD was longer in seminoma (4.9+/-6.1 mo) than in non-seminomatous germ cell tumour (NSGCT; 2.8+/-4.0 mo). DD was correlated with disease stage for the whole population (p=0.014) and for NSGCT (p=0.0009), but not for seminoma. DD had a significant impact on the 5-yr survival rate in the overall population (p=0.001) and in the NSGCT group (p=0.001), but not in the seminoma group. Global trends in mean DD did not change over the 20-yr study period, but we observed a slight decrease during the last decade.
DD is highly correlated with stage and survival in NSGCT. Urologists should promote programmes to enhance awareness and knowledge of testis cancer, so the diagnosis can be made more rapidly.
European Urology 01/2008; 52(6):1710-6. · 8.49 Impact Factor
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ABSTRACT: To report parameters in semen samples and sperm deoxyribonucleic acid integrity in a fertile volunteer presenting a 2-day fever of 39 degrees -40 degrees C.
Case report.
University-affiliated teaching hospital.
None.
Semen samples from a fertile volunteer of proven fertility were obtained and analyzed before the febrile illness episode and at days 15, 37, 58, 79, and >180 after the fever.
Semen parameters (total sperm count, motility a+b, and vitality), sperm protamination state, measured by sperm chromatin structure assay (SCSA) and apoptotic activities, measured by terminal uridine nick-end labeling (TUNEL) assay.
Total sperm count significantly decreased at days 15, 37, and 58 after the fever and returned to normal by day 79 after the fever. The percentage of motility significantly decreased at days 15 and 37 after the fever and returned to normal by day 58. Vitality score also showed a slight, although not statistically significant, decrease after the fever. The DNA fragmentation index (DFI, a SCSA parameter), which defines abnormal chromatin structure, significantly increased by 24% and 36% at days 15 and 37 after the fever, respectively, and decreased to 15% and 8% when reaching days 58 and 79 after the fever. High DNA stainability (HDS, a SCSA parameter) also significantly increased at day 37 after the fever. On the other hand, sperm DNA fragmentation, as measured by TUNEL assay, increased up to 23% by day 15 after the fever but this was not statistically significant.
This report demonstrates that a febrile episode can have marked effects on semen parameters and sperm DNA integrity. These results are particularly important for the counseling of infertile couples and in relation to assisted reproductive techniques (ART).
Fertility and sterility 10/2007; 88(4):970.e1-7. · 3.97 Impact Factor
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ABSTRACT: To review the state of progress of the various male contraceptive methods (with the exception of deferential methods).
A review of the literature was performed by using the key words: male/contraception, limiting the search to original articles in English and French. Articles on vasectomy and the other deferential methods of contraception are not considered in the present review.
Three methods of male contraception are widely used at the present time: withdrawal, male condom and vasectomy, although other types of male contraception have been shown to be effective, including hormonal contraception, which appears to be the most promising technique and the subject of the majority of research. Other contraceptive methods (immunological, thermal...) could constitute possible alternatives.
Male contraception remains under-used, as only male condoms are commonly used (apart from withdrawal and vasectomy). Consequently, new research protocols in the field of male contraception must be strongly encouraged.
Progrès en Urologie 05/2007; 17(2):156-64. · 0.58 Impact Factor
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ABSTRACT: To report parameters in semen samples and sperm DNA integrity in a healthy fertile volunteer over a 10-year period.
Case report.
University-affiliated teaching hospital.
None.
Semen samples from a nonsmoking healthy male volunteer of proven fertility aged from 40 to 50 years were collected and analyzed over a decade.
Semen parameters (sperm count, total sperm count, percentage of progressive motility grades a+b, morphology, and percentage of living spermatozoa) and sperm DNA integrity, measured by sperm chromatin structure assay (SCSA) and terminal uridine nick-end labeling (TUNEL) assay.
Median (min-max) value of total sperm count was 330 (126-511) million. Motility and vitality presented a median of 50% (40%-75%) and 78% (53%-92%), respectively. Among semen parameters, morphology and vitality showed the lowest within-subject coefficient of variation (CV(W)) and the total sperm count the highest (8.1% and 12.0% vs. 34.9%). Median values of DNA fragmentation index (DFI) and high DNA stainability (HDS) were 12.7% (7.9%-16.5%) and 6.5% (5.5%-8.2%), respectively. Sperm DNA fragmentation presented a median value of 8.9%, a minimum value of 1.4% and maximum value of 18.6%. Compared with TUNEL data, SCSA parameters (DFI and HDS) showed less variation over the data collection period (47.4% vs. 22.4% and 13.0%, respectively).
Our data show that in this healthy fertile volunteer, semen parameters and sperm DNA integrity remained normal, and no trend was observed over the study period. More interestingly, in this subject aged from 40 to 50 years old, sperm nucleus status presented less than 20% of sperm DNA fragmentation over a decade.
Fertility and sterility 12/2006; 86(5):1513.e11-8. · 3.97 Impact Factor
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ABSTRACT: We evaluated the prevalence of carcinoma in situ (CIS) in orchiectomy specimens performed for germ cell tumors smaller than 40 mm in diameter to propose an appropriate conservative approach to bilateral tumors or tumor of a solitary testis.
Of 127 patients treated with orchiectomy between 1990 and 2002, 41 who presented with a tumor of less than 40 mm in diameter were selected for histological analysis of testicular parenchyma. The morphological items assessed were CIS, spermatogenesis and Leydig cell hyperplasia.
CIS was observed in 39 of the 41 patients (95%). CIS was evenly distributed throughout the testicular parenchyma (ie around and beyond the tumor) in all 39 cases. Spermatogenesis was observed in 12 of 41 specimens (29%), spermatogenesis without spermatozoa was noted in 14 (34%) and absent germ cells were found in 15 (37%). Leydig cell hyperplasia was observed in 24 cases (58%).
Histological analysis of whole orchiectomy specimens showed that CIS is almost always present in testicular parenchyma adjacent to germ cell tumor. In bilateral testis cancer or cancer occurring in a solitary testis tumorectomy plus radiotherapy appears to be the appropriate treatment in patients with a small tumor and no other risk factors. In patients who wish to father a child and have preserved spermatogenesis the natural history of CIS allows the postponement of testicular radiotherapy after orchiectomy, giving the double advantage of preserving testicular endocrine function and maintaining the possibility of natural fatherhood.
The Journal of Urology 04/2005; 173(3):820-3. · 3.75 Impact Factor
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ABSTRACT: Sperm detection can be an important factor in confirming sexual assault in cases of rape. This paper compares two biochemical methods used in forensic medicine: the first detects the presence of zinc, the second detects acid phosphatase activity. The population studied was composed of 174 consenting women seen at the Male Infertility Center in Toulouse, France. The date of their last sexual intercourse was known accurately. Cytology was the reference test to confirm the presence of sperm in the vaginal samples. We studied the sensitivity, specificity, and positive and negative predictive value of the two biochemical methods. Acid phosphatase detection was the most valuable technique, but its use is limited in time. The zinc test gave disappointing results in our study and does not seem to be a useful reference method for the forensic physician.
Journal of Clinical Forensic Medicine 04/2003; 10(1):5-7.
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ABSTRACT: Investigation of the effects of body position and clothing on the temperature of the scrotum has given discordant results. The aim of the present study was to evaluate these effects in 13 fertile male volunteers in successive positions each held for 15 minutes, either Supine, Standing, Seated with legs apart, and Seated with legs crossed (n = 8) or Standing, Seated with legs crossed, and Standing (n = 5), at first naked and then clothed. The Standing naked position was that in which scrotal temperature reached the lowest point. Clothing increased the scrotal temperature compared with the naked state, whatever the position. The Seated with legs crossed position had specific characteristics: in the naked state, it was thermogenic and increased scrotal temperature as much as clothing in the Supine or Standing positions; in the clothed state, the increase in temperature was less than expected, which could indicate that local mechanisms are involved. Moreover, the Seated with legs crossed position had a persisting effect on scrotal temperature in the next position. These results have both pathophysiological and epidemiological implications.
Journal of Andrology 28(1):170-5. · 2.97 Impact Factor
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Journal of Andrology 26(2):163-8. · 2.97 Impact Factor
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Journal of Andrology 24(2):155-62. · 2.97 Impact Factor
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Journal of Andrology 23(1):18-22; discussion 44-5. · 2.97 Impact Factor
